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Morning headlines 12/15/17

December 14, 2017 Headlines No Comments

Software firm protests upgrade contract for UI’s Chicago med school

Cerner is protesting the University of Illinois medical center’s decision to award Epic a $62 million, seven-year contract.

21st Century Oncology To Pay $26 Million To Settle False Claims Act Allegations

21st Century Oncology will pay $26 million for fraudulently attesting to Meaningful Use, noting that “its employees falsified data regarding the company’s use of EHR software, fabricated software utilization reports, and superimposed EHR vendor logos onto the reports to make them look legitimate.”

120 people affected in health IT company Georgia facility changes

Greenway Health announces that it is laying off 120 employees and closing its Atlanta and Carrollton, GA offices as it moves to consolidate its headquarters in Tampa.

Preliminary Survey Findings: Impact of the Trump Administration on Health IT and Is Health IT in a Bubble?

A Health Growth Partners survey investigating the Trump Administration’s impact on health IT finds that 72 percent of respondents do not feel that the current administration has had any impact on business.

News 12/15/17

December 14, 2017 News 2 Comments

Top News


Cerner files a protest with the state of Illinois, claiming that it unfairly chose Epic for a $100 million project at UI Health, which uses both systems.


Cerner says its bid was lower and that it was not allowed to demonstrate its product during the selection. It also says that UI Health hired as its IT selection consultant Impact Advisors, which it says could benefit from an Epic selection, a charge Impact Advisors denies in saying it works with clients of all three UI Health bidders (Epic, Cerner, and Allscripts).

UI Health chose Epic in September 2017 with plans to replace systems from Cerner, Allscripts, and McKesson in a late 2019 go-live.

The health system responded to the protest by saying that it has experienced Cerner problems in the past; that Epic beat Cerner on RFP scoring; and Cerner wasn’t invited to do a demo because it failed a technical review.

UI Health says it twice tried to roll out Cerner ambulatory and failed both times due to system performance problems that it claims Cerner has admitted. It also notes that Cerner is ranked well below Epic by KLAS. Cerner pointed out that its academic medical center market share is significant and raises the question of how it failed the technical review, noting also that UI Health hasn’t upgraded its systems per Cerner’s recommendations.

Reader Comments


From Considerable Girth: “Re: White House EHR meeting. It’s interesting that as it was happening, the VA seemed to be digging deeper into Cerner’s interoperability capability as their planned contract signing data passed. Could it be that Cerner downplayed the idea of interoperability to make the case that the VA’s only hope of connecting to the DoD was to also buy Cerner? Rumor is that politicians and even some White House folks are puzzled at how Epic has connected to dozens of VA and DoD sites and 100 percent of Epic sites that are interested in sharing information.” Unverified. The VA, which planned to have its fast-tracked, no-bid Cerner contract signed by now, seems to be suddenly realizing that theoretical interoperability with the DoD and community-based providers isn’t necessarily a reality. That’s the kind of information that should have been fleshed out in performing due diligence, dictating strong contract terms, and convening stakeholders to define mutually agreeable goals, all of which seemed to have been skipped in the VA’s White House-pressured rush to sign a Cerner contract. Both the VA and DoD have awful track records in choosing, planning, and executing IT contracts and allowing cash-flush vendors and consulting firms to pull wool over their eyes, so somehow I don’t think everybody (especially veterans) lives happily ever after just because Cerner is running in both places. I have heard speculation from a couple of folks that Cerner might have de-emphasized interoperability to the VA to make its product seem like the only logical choice for connecting to the DoD, and while that’s just talk, the VA seems to be parroting that concept.


From Gert: “Re: MedKeeper. Was recently acquired, but the mystery is who bought them.” Unverified. The IV workflow technology company lists no press contacts or other ways to reach it beyond product sales or support, so I couldn’t ask.

From FormerCIO: “Re: Dirty Dirge’s data on CHI is incorrect – they have only 103 hospitals and the allocation of systems is also incorrect.” I don’t have access to the Definitive Healthcare database to which that reader referenced, so I can’t say, although he or she seemed pretty solid on the details.


From Bet on Black?: “Re: Allscripts. Paul Black claims 1 billion third-party API calls to Allscripts in 2017. Vendors such as Athenahealth, Epic, Cerner, and Meditech – what is your apples-to-apples comparison?” That’s an interesting question, although the admirable “openness” could be a measure of the business necessity of supporting a narrower product line. It also depends whether common integration – such as simply displaying another company’s external clinical reference information via an Infobutton – should be counted vs. sharing data with actual transaction systems. Or for that matter, if transaction count in general is more a function of client volume than technical capability. Putting out a press release invites competitive comparisons. UPDATE: Epic says they’re handling 900 million transactions per month via public APIs, 415 million per month to power customer-developed services, and 21 billion connections to/from Epic-provided services (such as mobile apps and MyChart). So we have Allscripts at 83 million transactions per month to external systems and Epic at 1.3 billion – Cerner, Meditech, and Athenahealth, you’re up, at least if you believe that interoperability is about competing vendors rather than simply being happy that the market has demanded and received API access to EHRs.

HIStalk Announcements and Requests


Welcome to new HIStalk Gold Sponsor Formativ Health. The company’s technology-agnostic patient access, revenue cycle, and practice operations services help patients feel like people and helps providers streamline operations, reduce leakage, improve insurance verification, and empower physicians to focus on keeping patients healthy. The 10-state, 450-employee company, based in New York City and a spinoff of Northwell Health, serves 3.5 million patients. It was selected a couple of months ago to provide management services to independent physicians via the Pennsylvania Medical Society’s Care-Centered Collaborative. Thanks to Formativ Health for supporting HIStalk.

This week on HIStalk Practice: 21st Century Oncology again finds itself in hot legal waters. HHS announces opioid code-a-thon winners. Clinicient acquires Keet. Infinity Behavioral Health Services acquires Health Assets Management. Greenway announces Georgia closures, layoffs. Alivio Medical Center joinsVillageMD. The FTC warns privacy-conscious consumers about at-home DNA testing kits. PRM Pro Jim Higgins shares five technological advances improving primary care communication.


I sometimes cringe upon reading negative comments left on my annual Reader Survey, no different than a mother being told by a stranger that her child is ugly. Still, I take some comfort in the many positive observations and the fact that even critics are apparently still reading HIStalk despite the flaws they perceive. I spend many hours each day writing it and ask only that you spend maybe three minutes completing the once-yearly, one-page survey to provide hopefully constructive input. You get the pride of participating in the democratic process, the satisfaction that you didn’t have to wait in a freezing voting line, the freedom from being harassed at the polls, and the hope of winning a $50 Amazon gift certificate. I’m secretly hoping that the Russians try to rig the vote.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock


The struggling Lifespan (RI) and the struggling GE (in the form of GE Healthcare) will collaborate in trying to save the health system $182 million over six years by identifying inefficiency using “cutting-edge analytics and tools.” Recently tanking GE shares are trading at their 1997 prices after a couple of bursts of misplaced investor enthusiasm, the Dow’s biggest loser since 2001 when Jeff Immelt took charge.


One-time high-flyer Greenway Health will close its Atlanta and Carrollton, GA offices in January and lay off 120 employees there as it moves operations to its Tampa, FL location. Greenway announced in October that it would merge functionality from all of its EHR/PM products into a next-generation product, but also said at that time that it would leave customer support intact in Carrollton while moving some functions to Tampa. The company was ironically recently named as Atlanta’s “Top Workplaces 2017” by the Atlanta newspaper. Greenway Health was created in 2013 as a repackaging of three holdings of its new private equity owner – publicly traded Greenway Medical Technologies, Vitera Healthcare Solutions, and SuccessEHS. Vitera was formerly Sage Software, which had purchased the former Medical Manager PM/EHR from Emdeon. Carrollton, population 25,000, is now stuck with an albatross of a street name since the soon-to-be vacated Greenway headquarters building sits on a street also named Greenway.


New York EHealth Collaborative chooses Verato’s Auto-Steward for automating the correction of MPI patient mismatches on the SHIN-NY HIE.

In Canada, six-hospital CHAMP will implement Meditech’s Web EHR.



Peter Pronovost, MD, PhD — Hopkins Medicine SVP for safety and quality and perhaps healthcare’s most influential quality expert — will join insurer UnitedHealthcare as SVP of clinical strategy.

Announcements and Implementations


The HIMSS-owned Personal Connected Health Alliance releases new Continua Design Guidelines that support patients sharing data with providers.

Meditech will offer the patient electronic signatures solutions of Access in its cloud-based Web EHR subscription offering.

Government and Politics


Florida-based cancer treatment center operator 21st Century Oncology will pay $26 million to settle federal charges that submitted false Meaningful Use attestations that included falsified EHR usage data and phony utilization reports onto which it Photoshopped EHR vendor logos. The settlement also covers whistleblower-reported alleged Stark Law violations involved with paying doctors based on how many patients they referred to company-owned labs and radiation centers. 21st Century Oncology filed Chapter 11 bankruptcy earlier this year to protect itself from creditors and several fraud lawsuits.


A Chicago Tribune report finds that medical regulation is so lax in Illinois that “even the most desperate of doctors can find financial reward,” pointing out the fraud-filled home health industry that finds it easy to swindle Medicare and Medicaid. It notes that anyone can start a home health business by just paying a $25 license fee with no criminal background check required, leaving them free to troll public areas to recruit patients which, under Medicare rules, don’t have to be certified for care first.

HHS OIG approves a small pilot project in which medication management pharmacists employed by a Medicare Advantage plan will receive real-time discharge information from the hospital’s EHR to help reduce readmissions, which OIG says won’t run afoul of anti-kickback rules.


A former Johns Hopkins Health System patient appointments supervisor files a False Claims lawsuit claiming that he was ordered to “fill the plane” with patients from outside Maryland to skirt state limits on revenue paid by residents. The plaintiff says the health system’s medical concierge service prioritizes appointments for out-of-state patients as directed by top brass.

The FCC, as expected, reclassifies broadband providers as information services rather than telecommunications, reversing its 2015 ruling and freeing those companies from FCC oversight and thus allowing them to selectively prioritize or price traffic to any given website as long as they disclose their practices. Several states have already announced lawsuits challenging the decision. The broadband providers have declined to promise that they won’t do exactly what everyone fears, and unlike money-grabbing cable providers that can be easily fired, there’s no much of a cord-cutting option for the Internet unless you count cellular data. The only tiny consolation is that they didn’t abuse their customers too much before 2015, but that was a long time ago in Internet years.



Eighty percent of the 500 C-level health IT executives surveyed by Healthcare Growth Partners report no impact on their business from the Trump administration’s activities and potential ACA changes, although the report notes that provider IT capital budgets were already in place for 2017 by Election Day. The number of executives who believe health IT is in an investment bubble increased from to 36 percent from 29 percent on 2015.

In Scotland, outpatients at Glasgow hospitals miss 12 percent of scheduled appointments, with 20-something men being the least reliable. NHS Greater Glasgow plans to enhance its automated text and call reminder system to require patients to respond to prevent their appointment from being given to another patient.


Texas medical resident Rachel Pearson, MD/PhD pens an Onion-worthy letter to the editor of a magazine, complaining that none of her patients have worked a day in their lives, they are ungrateful, they vomit and pee on her, and they have to be bribed to be examined. It’s a tongue-in-cheek reference to the still-unfunded federal CHIP program that insures most of her pediatric patients.


A hospital in China suspends a radiologist after she is caught on video playing a phone game while performing a CT scan.

Sponsor Updates

  • AdvancedMD is named a leader in Gartner’s “FrontRunners for Mental health” quadrant.
  • Spok publishes an explainer video for its Care Connect product.
  • Medhost customer Mt. San Rafael Hospital (CO) becomes one of the country’s first to meet MU Stage 3 objectives.
  • Liaison Technologies awards its second Data-Inspired Future Scholarship to AI-focused high school senior.
  • Leidos Health publishes a white paper titled “From Good to Great: Strategic EHR Optimization Can Get You There.”
  • Clinical research network TriNetX adds Natural Language Processing to extract information from physician notes and clinical reports, link it to other EHR data, and then present the combined information to researchers who can then design studies and identify potential patient participants.
  • Logicworks launches targeted professional services portfolio for AWS.
  • PokitDok becomes the first healthcare technology company to achieve CAQH CORE Phase IV Certification.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
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EPtalk by Dr. Jayne 12/14/17

December 14, 2017 Dr. Jayne 1 Comment

When we think about healthcare IT systems, I think most of us probably overlook some of the quasi-healthcare vendors that patients have to deal with to handle their medical bills. A friend vented to me about his company’s choice of a new benefits administrator, which needs to use to access his flexible spending account. This is the same company his employer used in the past, but switched to another benefits administrator last year, and is now switching back to the first one.

He received a message to establish his account to be ready for 2018, but when he tried to execute on it, he received a duplicate warning and was referred to customer support. The site then generated a password reset link, which didn’t help him due to the duplicate accounts. After opening a second help ticket, he received a secure message notification in his employee email, which required him to create a secure messaging account on the benefits website, using his work email as the user name and creating a new password.

Despite having the same login as the benefits site (as well as the same look and feel) the secure messaging portion of the site is entirely independent, and the messages he had been sent were not useful. Returning to the benefits site, he tried again to have his account unlocked, and four days later, finally received a secure message that his duplicates were resolved.

Once he was able to access the benefits site, he discovered there is no linkage to the secure messages from that side either, so users have to go in and out of two different systems if they need customer support. I’m going to go out on a limb with the idea that maybe this is intentional, since money left in flexible spending accounts is forfeit if not used. If the system is difficult to navigate, there’s a chance it will prevent employees from using their benefits.


Speaking of difficult to navigate, I tried to complete my HIMSS18 registration today since the early bird discount is ending. It kept replacing the name of my company with “DX” for no apparent reason, forcing me to log in and out a couple of times. I also had trouble getting the name badge fields to correctly show my city, since I wanted it to display Big City instead of Nameless Suburb in the field. I finally gave up and will try again tomorrow. It looks like my hotel of choice is sold out, so I’m glad I made my reservations a couple of months ago.

I’ve already started building my agenda for the week, including at least one BFF Booth Crawl. Although I’m not fond of Las Vegas, I do enjoy catching up with my healthcare IT friends. For the third year HIMSS is hosting a reception for Millennials. I’m tempted to sign up just to check it out and see how the conversations differ from the other events such as the Women’s Networking reception. I’m too old to pass for a Millennial, but I bet I could pass for a hip older coworker.


It’s the time of year when holiday cheer abounds. I was surprised to receive a notice about the American Medical Association’s “Joy in Medicine” modules and the fact that the American Board of Family Medicine is going to provide Performance Improvement Credit for providers who complete them. I’ve focused most of my Maintenance of Certification and Continuing Medical Education activities on being a competent, compassionate, and culturally-sensitive physician and have completed more than enough credits for 2017. The idea that physicians need to complete coursework to learn how to find the joy in medicine again is a sad commentary on healthcare today. The course is promoted as having tools “to guide the executive leadership teams in creating a joyful practice environment and thriving workforce.”

I gave it a glance, and it does touch on physician burnout but not on the high rate of physician suicide – I guess that wouldn’t be very joyful, but it is a reality. I’ve lost two colleagues with bright futures to suicide and agree that we need to have better support structures, not only for physicians, but for all caregivers and people trying to work in our crazy healthcare system. The module advocates creating a “wellness infrastructure” with a chief wellness officer reporting directly to the CEO or equivalent to other leaders such as the COO or CMO “and is resourced accordingly.”

It goes on to say that “this leader should ensure all leadership decisions consider the potential effect on workforce wellness.” Even though it offers a calculator to estimate the true cost of physician burnout, I don’t see this playing in most of the arenas where physicians are employed. Especially in the under-20-provider practice, it’s going to be hard to create that infrastructure. I’m working with a five-doctor group now that can’t even agree on how overnight call should be distributed, so getting them to have a conversation on workforce wellness would be quite the trick.

Speaking of pipe dreams, Aetna wants to create a healthcare hub at CVS pharmacies to help patients navigate the healthcare system. Likening it to Apple’s Genius Bar, Aetna CEO Mark Bertolini explained it as a cross between the Patient-Centered Medical Home model and a retail establishment where people can walk in and get help.

It’s this kind of over-simplification of patients’ true needs that gets my blood pumping. The infrastructure required to truly make this work is vast, and although CVS trots out its MinuteClinic retail clinic sites as part of the solution, it’s more complicated than it seems. My practice sees many patients who are beyond the narrow care protocols in place at MinuteClinic, and the referral of their patients to a second visit at Urgent Care actually adds to the healthcare system. Do we really think that CVS is going to triage customers away from its clinics to competitors, or are they going to try to expand into the primary care and urgent care space? Or do as they do, and see the patient first, then refer to a higher level of care? Will they send the patient to their primary care physician or offer to sell over-the-counter remedies? I’m hoping the former, but since retail profits are important, the balance might be tricky.

The simplicity of comparing healthcare to the Apple Store also masks the complexity of patients. Where Apple offers service on a set number of products, the number of “models” walking into a healthcare environment is infinite. Although basic processes can be put into place to handle subsets of patients and conditions, I hope CVS and Aetna folks truly engage with their stakeholders to create the model. First and foremost, this needs to be about doing what’s right for patients rather than shareholders. I’ll remain skeptical until I see drafts of their pilot plans. Or, if they’re looking for an anonymous physician blogger to give them advice, I’m available.

What do you think of the Aetna/CVS merger? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/14/17

December 13, 2017 Headlines No Comments

This Startup Wants to Democratize CRISPR Gene Editing Research By Making It Free

A Venrock-backed startup called Inscripta is releasing an alternative CRISPR-Cas9 enzyme that scientists can use for free to conduct research. CEO Kevin Ness reports, “You can go right to the website, download the sequences instantly, even get a user guide.”

A health care paradox: measuring and reporting quality has become a barrier to improving it

A STAT opinion piece explores the conflicting dynamic between “patient-centered care and the administrative burdens that measurement imposes on physicians, hospitals, and health systems.”

New CDC head faces questions about financial conflicts of interest

CDC Director Brenda Fitzgerald recuses herself from decisions involving health IT and cancer detection because her and her husband are legally required to retain equity in companies involved in both markets.  Senator Patty Murray (D-WA) is questioning her ability to function in her role if she is unable to engage in conversations around cancer care, the second leading cause of death in the US.

Email is the biggest source of data breaches

A new survey finds that email is the leading cause of data breaches in healthcare, contributing to 73 breaches thus far in 2017, affecting 574,000 people.

HIStalk Interviews Eric Ritchie, COO, Minnie Hamilton Health System

December 13, 2017 Interviews No Comments

Eric Ritchie is COO of Minnie Hamilton Health System in Grantsville, WV.


Tell me about yourself and the organization.

We’re a Federally Qualified Health Center that owns and operates a Critical Access Hospital and rural health center in Grantsville, West Virginia. It’s an unusual designation, only of about one of three in the country where an FQHC owns and operates a Critical Access Hospital. I’m originally from the area that we service.

Minnie Hamilton has been operating this way for approximately 21 years. We operated as a standalone clinic prior to 1996 before taking over responsibility for the recently-closed Calhoun General Hospital, which had serviced the area prior to that for the previous 30-plus years.

What are your biggest challenges in running the health system?

The biggest challenge is definitely related to our rural location. We service an area that doesn’t have a lot of industry — actually it has no measurable industry — so it is an aging population. A lot of the younger generations, to provide a lifestyle for themselves, move beyond our service area. Our average patient age goes up every year, according to the demographic.

The lack of infrastructure that comes with being in rural West Virginia makes it challenging. Your patients have difficulty getting out to get their healthcare needs satisfied. When they do come to our facility, if they need a more specialized facility or a bigger hospital, there’s always a logistical challenge getting them out in a timely manner to meet those emergent situations.

The rural location is probably our number one biggest challenge and the disadvantages that come with that. Definitely in the state of West Virginia, it’s well-documented that our infrastructure, from an IT standpoint, is challenged. We also deal with that as well.

What are your most significant IT systems?

When we selected Athenahealth as our EHR, it was our goal to try to get it all under one umbrella from an IT standpoint. Athena is primarily it. We have standalone dental software that runs our dental clinics. We also operate a long-term care facility that has its own system. Beyond that, it’s just our traditional phone system. We have a partnership with Microsoft that we leverage their Office suite free of cost because we’re a not-for-profit.

What are you doing with population or community health?

We are the continuum of care for most of our patients. We put a lot of focus on identifying, as our patient demographic ages, what their predictable needs will be in the coming years. As a facility, we have evolved over the last 20 years, as our demographic has aged, to make sure that we are providing services that prevent them from having to make that hour, hour and a half commute.

A big population in our area has diabetic needs, so we’re looking at what’s coming down the pike. A need for dialysis, more so than there is right now. That was the reason why we opened the dental clinic, to address the younger population that does exist. The long-term care was another one of those solutions.

We have a pretty simple formula. We do quarterly analysis on the referrals that we are having to send out to other facilities because we don’t provide a service. When we see a need rise up to the level affecting a measurable percentage of our population, we start exploring ideas on how to bring that service here locally, whether it’s something that we provide under our umbrella or that we simply provide space for another entity to come in and perform those services here.

You are surrounded by WVU Medicine and the trend nationally is that the big systems are getting bigger. How do you see the future of Critical Access Hospitals, both in West Virginia and across the country?

It’s very interesting and a popular topic among the Critical Access Hospitals when they get together and talk. In West Virginia, we see two predominant, large entities that are acquiring Critical Access Hospitals. WVU Medicine to the north, which is acquiring different practices up there, and then Charleston Area Medical Center to the south.

We have a good relationship with both. Right now we’re partnering with WVU Medicine, where they are sending specialists to our facility to hold office hours. They take care of the billing, so they’re not working under the Minnie Hamilton umbrella, but they are bringing much-needed services to our areas, eliminating the need for our patient population to drive extended miles to receive that service.

It really comes down to, in our experience, open communication. This is what our needs are. This is how we can help each other. Our loyalty stops at our patient population, so whatever is in the best interest of that patient population, we are going to use that as our guiding light to determine how we should move forward.

There’s always a balance where a big health system could provide resources, but they if they were to acquire the hospital, they might decide it’s not worth keeping open or they might not respect its original mission.

Based on the conversations that we’ve had with those larger entities, I think there is a real shift in the view of how a larger entity partners with a Critical Access Hospital. Our patient population is predominantly Medicare or Medicaid. That’s a financial benefit for us because of being a Federally Qualified Health Center. It doesn’t make as much sense financially for a bigger entity to become servicing a population that is predominantly Medicare or Medicaid.

What everyone is starting to realize, or at least in our experience, is that it makes more sense if we can provide the care here locally and keep that patient population close to their home place. But we are dependent on those bigger entities to provide the knowledge and the skill sets. Rather than taking over and starting to operate a Critical Access Hospital under their umbrella, I think it benefits them in the long run if they can simply be recognized as a partner to an existing Critical Access Hospital who is servicing the rural part of America. But at the same time, not overwhelming their own systems with a patient population that they can’t handle.

They want those beds. They want the ability to make sure that care is being provided. But they can’t afford to continue to expand and just increase their bed count. It makes more sense for a standalone entity like Minnie Hamilton to take care of the daily, routine illnesses or chronic illnesses that can be monitored and managed. When that special occasion comes up that exceeds our skill set, we have a direct line to a solution that can come and be a part of that care team.

The advantage big systems have is that they have other sources of revenue, while you are at the mercy of what happens in Washington, DC.

You really are. That is a burden carried by all Critical Access Hospitals. Even the bigger entities have that concern, but our reimbursement and our ability to remain operational goes as Congress and the legislature decide to fund the healthcare programs. We can in no way be profitable without that federal supplement. We just don’t have the volume to generate the revenue that’s required to run the facility as we have it set up now.

The alternative is that if a facility like ours ceased to exist in our service area, we’re looking at a two-hour time lapse for an emergent situation. We all know what numbers end up being when you’re taking 120 minutes to respond in an emergent situation.

Government officials, elected officials, those bigger entities all want to be a part of a solution that allows rural America to continue to be served by a staff capable of taking care of an emergency situation, as well as those that have chronic illness or the routine acute type settings. So they aren’t required to travel an hour and a half or  two hours for care.

You had some previous problems with revenue cycle management and the cost of your IT systems. What are the lessons learned from that experience?

With a smaller entity like Minnie Hamilton or many of the Critical Access Hospitals, you need to stay very current on the rules and regulations governing reimbursement. Insurance companies continue to become more and more business-like in the sense of identifying ways and criteria that all of us have to be well-versed in and know how to apply it to maintain a level of reimbursement that we have historically experienced.

One of the ways that Minnie Hamilton is navigating that right now is that we’re making sure that we partner with vendors that bring something to the table with regards to knowledge of those ever-evolving rules and regulations. We feel it’s best for us not to bear that responsibility solely by ourselves. There’s just too much at stake.

You make partnerships. You look for vendors who have a vested interest in not only understanding those rules and regulations, but helping you as the client understand those rules and how best to leverage them. Keeping you compliant with the ever-changing regulations that are being passed down annually, whether it’s MIPS, MACRA, UDS reporting, or HEDIS reporting. For us, that is the guiding principle behind identifying possible vendors and then ultimately selecting vendors. That has to be a component of that relationship.

Given the challenges your health system has, what makes you want to keep coming to work every day?

We’re fortunate at our facility because we’re smaller. Our executive team at Minnie Hamilton all grew up within 30 miles of this facility. The patients we are serving are our family members, extended family members, or friends of family members. It’s easy for me, and really all of our staff, to recognize why we do what we do and why we deal with the headaches that we deal with.

In my experience in West Virginia, even in the bigger entities, a lot of the folks that I deal with on a daily or weekly basis are from the area or are from areas that have a lot of similarities to the demographic makeup of the state. At the core, almost anyone I’ve met in healthcare started out at more of an introductory level. At the heart of it, they’re motivated solely by that moral compass of just wanting to do right by the patient population.

Morning Headlines 12/13/17

December 12, 2017 Headlines 1 Comment

Health IT company that sued VA goes after Cerner’s patents

Following a failed legal attempt to block the VA’s no-bid Cerner deal, CliniComp is now suing Cerner directly, citing patent infringement of a 2003 patent that describes remote hosting of a hospital IT system.

Aetna wants to create a ‘Genius Bar’ at CVS, and it could forever change the way Americans access healthcare

On a recent earnings call, Aetna CEO Mark Bertolini described plans to roll out CVS-based ‘health hubs’ that would provide patient navigator services. He likens the service to Apple’s Genius Bar, and explains that in this case, employees would be “preparing them for their visits, setting up appointments, eliminating prior ops, doing all those other sorts of things to help navigate that system for them.”

Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer

An cross-sectional analyses of 32 deep learning algorithms designed to review pathology images concludes that seven deep learning algorithms performed better than “a panel of 11 pathologists in a simulated time-constrained diagnostic setting.”

NewYork-Presbyterian and Walgreens Collaborate To Bring World-Class Care Through Telemedicine

NewYork-Presbyterian will begin offering telehealth services provided by its ED doctors to non-emergency patients at local Walgreens.

News 12/13/17

December 12, 2017 News 5 Comments

Top News


CliniComp, fresh off its failed legal challenge of the VA’s choice of Cerner in a no-bid contract, sues Cerner for patent violation.


CliniComp says Cerner violated its 2003 patent for a remote hosted hospital system.

Reader Comments


From Dirty Dirge: “Re: big health system mergers. Who wins, Epic or Cerner?” I would instead ask whether the potential benefits of standardizing systems justify ripping and replacing existing EHRs when their sites cover a big swath of geography without much service area overlap. Maybe it’s OK to limit patient information exchange to the basics, like CCDs, since patients rarely seek care outside their local area. The most compelling argument would be populating a single database that can support analytics, operational analysis, research, and best practices, but that could theoretically be done on the back end with a lot of semantic data translation. The only comparably sized  model is the Kaiser’s use of Epic, but their implementation happened a long time ago; they have more focused corporate control than I would expect of newly merged health systems that can’t even name a single CEO; and Kaiser controls more of the patient experience as an insurer as well as a provider. Perhaps most at risk are Allscripts ambulatory or Meditech in sites included in the merger plans. My guess would be that the highest-priority system projects would involve administrative systems to allow executives to get a handle on their sprawling enterprises. We are really entering uncharted territory since most “huge” health systems have revenue of $2-5 billion vs. the dozens of billions that the proposed mega-mergers would create. Lower-tier vendors should take note – as hard as it already is to sell systems, it’s about to get a lot harder when you have to earn face time with a CIO who controls the IT strategy and budget of more than 100 hospitals (in comparison, Kaiser has only 39 hospitals).

Associate CIO provides these merger-related figures from Definitive Healthcare:

  • Dignity Health’s 48 hospitals run Cerner Millennium.
  • Catholic Health Initiative’s 153 hospitals use Cerner (61), Epic (65), and Meditech (27), also on the ambulatory side running McKesson (4) and Allscripts (21).
  • Ascension Health’s 132 hospitals use Cerner except for Providence and Wheaton Franciscan, which use Epic.
  • Providence St. Joseph’s 58 hospitals use Epic (37), Meditech (19), and Allscripts (3).

In terms of dominant vendor in the two proposed mega-mergers, it’s obviously Cerner over Epic (109 vs. 65 and 130 vs. 39, respectively). Here’s a fun opportunity for Definitive or HIMSS Analytics to list the major systems (beyond just the EHR) used by these health systems that are contemplating merging.


From Comprn: “Re: Lifepoint Health. RIF including multiple VPs, about 25 FTEs, due to lower-than-expected earnings.” Unverified. The 72-hospital company cut its revenue and profit forecasts in late October due to fewer-than-expected admissions for the fiscal year. LPNT shares are down 15 percent over the past year vs. the Nasdaq’s gain of 27 percent, valuing the company at $2 billion. It’s probably tough competing with systems bigger than yours that don’t pay taxes and that are equally profit-motivated.


From Trust but Verify: “Re: White House EHR meeting. A news site says [publication name omitted] broke the story but I saw it two days before on HIStalk.” Correct. An anonymous reader sent me the agenda via my Rumor Report online form and I posted the information in Sunday night’s post. Nobody else ran anything that I saw until at least Monday morning, so I’m pretty sure all mentions were triggered by reading it on HIStalk. One site that emailed me late Sunday ran their item (with the agenda that I sent them) Monday morning, but didn’t give credit. I’m also surprised at news organizations that cite one particular health IT website as a source when it’s pretty much like Wikipedia, with no original content.

HIStalk Announcements and Requests

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Cumberland Consulting Group’s employee volunteer and community action group donated $1,000 to my DonorsChoose project, which with matching funds from my anonymous vendor executive and other sources funded the entire cost of these projects for high-need classrooms:

  • Take-home family math activities for Ms. D’s elementary school class in Houston, TX.
  • Hands-on math games for Ms. K’s first-grade class in Indianapolis, IN.
  • Games for science game night for Mrs. S’s elementary school in Gautier, MS.
  • Microscopes, telescopes, and science kits for Mrs. B’s elementary school class in Gulfport, MS.
  • Take-home science activity kits for Mrs. M’s elementary school class in Chattanooga, TN.
  • STEM kits for Mrs. M’s elementary school class in Paterson, NJ.
  • STEM books and activity kits for Mrs. H’s elementary school class in Sugar Creek, MO.
  • Programmable robots for Mrs. G’s elementary school class in Brownsville, TX.
  • After-school science kits and supplies for Mrs. P’s elementary school class in Pocatello, ID.
  • 200 sets of headphones for Ms. C’s elementary school class in Provo, UT.
  • STEM project kits for family game nights for Ms. M’s elementary school class in Fayetteville, NC.
  • Programmable robots and a Chromebook for Mrs. G’s elementary school class in Miami Gardens, FL.
  • STEM kits for Ms. T’s elementary school class in Bronx, NY.
  • STEM project kits for family game nights for Mrs. H’s elementary school class in Canyon, TX.
  • Programmable robots for Mrs. F’s high school class in Glen Dale, WV.
  • STEM activity kits for a student-led STEM gender and ethnic diversity project of Mrs. I’s high school class in Orangeburg, SC.
  • Math and science resources for Ms. S’s first-grade class in Dayton, OH.
  • Headphones for the technology lab of Ms. W’s elementary school class in Memphis, TN.


Can you please take 3-5 minutes to complete my once-yearly, one-page HIStalk reader survey? I’ll use the results to plan for 2018, but if you need even more motivation, I’ll be randomly drawing respondents to win a $50 Amazon gift card. Thank you.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock


Population health management systems vendor SymphonyCare acquires Influence Health’s Empower patient portal business.


Physician scheduling system vendor QGenda acquires ED physician scheduling software vendor Tangier.


Aetna CEO Mark Bertolini tells investors that he envisions that a merger with CVS would allow placing health hubs in pharmacies that would serve as health system navigators, especially for the 60 percent of people who don’t have a regular doctor. He says it could work like the Genius Bar in Apple Stores.


Nashville-based health IT staffing firm ALKU acquires Holland Square Group, a health IT consulting firm also based in the Nashville area. Holland Square Group is a DoD MHS Genesis subcontractor under Leidos.



OhioHealth (OH) chooses Casechek’s implant supply chain automation.



Hans Morefield (Experian) joins substance use disorder technology vendor Chess Health as CEO. The company’s executive chair is industry long-timer John Holton.


CTG hires Jeff Gerkin (Manpower Group) as EVP of sales.


Brett Jarvis (LinkedIn) will join Solutionreach as SVP of customer success.

Announcements and Implementations


Mental and behavioral screening software vendor AssessURhealth offers its app on the Athenahealth Marketplace.


New Jersey’s state medical society brings its OneHealth New Jersey HIE live.


Legacy Data Access will offer its 800 hospital customers a hosted, AI-powered clinical data service in partnership with Life2.


Firelands Regional Medical Center (OH) goes live on Meditech’s Web EHR.


New York – Presbyterian installs telemedicine kiosks in some of its New York-based Duane Read drugstores, making its ED doctors available to review problems that are not life-threatening.


Ground was broken this week on what would have been Cerner CEO Neal Patterson’s 68th birthday on the Patterson Health Center, a $41 million critical access hospital on the Kansas-Oklahoma border that is mostly funded by the Patterson Foundation. The facility, which combines two existing hospitals that merged on November 1, will offer a 15-bed hospital, health clinic, rehab services, a wellness center, and public green space. The family was represented by Neal’s nephew Alan Patterson:

Uncle Neal never really left the farm. He came back to Harper County just about any chance he had. Even after he was a big shot on the cover of Forbes Magazine, he came home at harvest to drive a combine, bring meals to the field, and hang out with the guys when the work was done. If you drove by the farm, you would often see him running the company from a laptop while sitting on the front porch of the farmhouse where he grew up. To me, he was a big kid who was 30 years older than me but enjoyed doing the same things I did. He was like another high school buddy would come back to visit his parents and hang out …  Neal traveled the world and he saw something troubling that most of us don’t see. He saw that small towns were in a healthcare crisis and they were being left behind. He saw that people in rural areas had poorer overall health compared to people in bigger communities. Little hospitals were not the most profitable areas of the business, nor the ones that would help ensure his company made quarterly earnings… but he did not care. He knew that good healthcare facilities and technology were important to rural communities

Government and Politics


A Wisconsin judge dismisses the revenue cycle system lawsuit that Agnesian Healthcare filed against Cerner, noting that Agnesian’s contract requires it to submit to arbitration in Cerner’s home state of Missouri instead of suing. Anesian claimed in the now-dismissed September 2017 lawsuit that a botched RCM conversion from McKesson to Cerner in 2015 cost it $16 million in revenue and $200,000 per month due to coding and billing errors, while Cerner insists that it fixed the problems in 2016.


CDC Director Brenda Fitzgerald is recusing herself from issues related to health IT and oncology because she is legally required to keep her illiquid investments in LLCs involving Greenway Health (EHRs) and Isommune (cancer detection). Fitzgerald – a former OB-GYN, Air Force major, and commissioner of Georgia’s Department of Public Health – and her ED physician husband reported assets valued at up to $16 million.


The New Yorker profiles “Estonia, the Digital Republic,” describing how the post-Soviet republic of 1.3 million people transformed itself into a digital society that embraces robots, a personalized chip ID, making nearly all business and personal information available online, giving every person ownership of data recorded about them, and a “once only” policy that pulls in existing information for everything from buying a house to seeing a doctor.  The country is reconsidering the definition of “population” by connecting virtual talent in an “e-residency” program that allows citizens of other countries to become residents of Estonia with access to digital services without ever setting foot in the country. Some snips from the fascinating article:

“I’ll show you a digital health record,” she said, to explain. “A doctor from here”—a file from one clinic—“can see the research that this doctor”—she pointed to another—“does.” She’d locked a third record, from a female-medicine practice, so that no other doctor would be able to see it …  E-ambulance is keyed onto X-Road, and allows paramedics to access patients’ medical records, meaning that the team that arrives for your chest pains will have access to your latest cardiology report and ECG. Since 2011, the hospital has also run a telemedicine system … Rita Beljuskina, a nurse anesthetist, led me through a wide hallway lined with steel doors leading to the eighteen operating theatres. Screens above us showed eighteen columns, each marked out with 24 hours. Surgeons book their patients into the queue, Beljuskina explained, along with urgency levels and any machinery or personnel they might need. An on-call anesthesiologist schedules them in order to optimize the theatres and the equipment … She logged on with her own ID. If she were to glance at any patient’s data, she explained, the access would be tagged to her name, and she would get a call inquiring why it was necessary. The system also scans for drug interactions, so if your otolaryngologist prescribes something that clashes with the pills your cardiologist told you to take, the computer will put up a red flag.

Privacy and Security


An Accenture-conducted, AMA-sponsored survey of 1,300 physicians survey finds that 83 percent have experienced cyberattacks and want cyber hygiene tips, a guide on conducting a risk assessment, and easy-to-understand HIPAA instructions. The survey’s methodology isn’t the best, however:

  • Respondents were apparently self-selected and only completed an online survey.
  • If only AMA members were polled (the report doesn’t say), that would be only a tiny, non-representative subset of all US doctors.
  • Respondent demographics were not provided, such as the size of their practice site or whether they work for a health system.
  • Half of respondents say they have an in-house security official, although the question wasn’t asked about that person’s time allocation and credentials.
  • More than one-fourth of responding physicians say they have outsourced security management, but the survey didn’t ask what that means.
  • More than half of respondents say someone clicked on a phishing link, which doesn’t really seem like a cyberattack unless it resulted in downtime.
  • Only 37 percent reported that an employee inappropriately accessed PHI, which is surely low.



Apple will launch the IMac Pro this week at an entry price of $5,000 for 32 GB of memory and 1 TB of storage and up to $17K for a fully loaded machine, testing the limits of just how much of an Apple tax even professional users are willing to pay. It’s not an Apples-to-apples comparison, but my Acer laptop has 16 GB, 1 TB (along with a 128 GB SSDD for running Windows 10) and cheap available upgrades and I only paid a bit more than $500. Even that capacity is excessive since nearly everything I use is on the Web.



Two-thirds of the few dozen interviewed patients who got their lab results via a clinic’s patient portal weren’t given further explanation, sending most of them to Google to try to figure out what the results mean. The article concludes that just displaying lab numbers on a portal isn’t enough, especially for patients with abnormal results.


In Canada, all-digital Humber River Hospital opens a Meditech-powered, 4,500-square-foot Command Centre in which staff monitor real-time incidents such as delayed care and provider workload issues. It also contains a 26-panel GE Wall of Analytics with live video feeds from patient care areas.


A just-published review of a 2016 Netherlands bake-off of 32 algorithms that analyze tissue slides to detect breast cancer metastasis finds that seven performed better than a panel of 11 pathologists when limited by typical workflow time constraints. The best algorithms performed equal to the pathologist panel when time constraints were removed. 


A review of 1,300 clinic visits finds that patients asked their doctors for specific lab tests, referrals, pain meds, other medication an average of once per visit; the doctor agreed to write the order for what they wanted 85 percent of the time; and those patients who were turned down gave the doctor lower satisfaction scores.


Javon Bea, CEO of five-hospital Mercyhealth (WI), was paid $8.38 million in 2016, far more than basically any charity or health system. The newest tax form I found was from 2014 and even then the CIO made over $750,000. Maybe nobody wants to live in Janesville, WI or work for Mercyhealth if they have to pay that much. Axios notes that even under his previously slightly lower pay, Bea earned $72 per patient day, although he told the local paper that his then-$3 million paycheck had no impact on healthcare costs even as he increased the system’s revenue from $33 million to $1 billion. 

Sponsor Updates

  • Spok launches a library of stories illustrating the ROI of clinical communication technology.
  • Optimum Healthcare IT completes its work as primary partner for UCI Health in its Epic Connect strategic partnership with UC San Diego Health.
  • Change Healthcare SVP of Product Development and Technology Michael Wood joins the 2018 Class of the Nashville Health Care Council Fellows.
  • AssesURHealth raises $2,700 for the American Foundation for Suicide Prevention as part of the Out of the Darkness Tampa Bay Walk.
  • Change Healthcare will integrate Tibco’s Connected Intelligence product line with its products.
  • Besler Consulting releases a new podcast, “S10 changes you should know about.”
  • Glassdoor includes CoverMyMeds in its list of Best Places to Work in 2018.
  • Diameter Health achieves NCQA Certification for all 2017 e-measures.
  • Vyne’s Trace and FastAttach solutions earn HITRUST CSF certification.
  • EClinicalWorks will exhibit at the New York Society for Gastrointestinal Endoscopy 41st Annual New York Course December 14-15 in New York City.
  • The “I Love Madison Podcast” features Healthfinch VP of Finance and Operations Leah Roe.
  • Technology Headlines Magazine names Intelligent Medical Objects CEO Frank Naeymi-Rad one of the 50 Most Admired CEOs of 2017.
  • ConnectiveRx publishes a new white paper, “Boost prescriber knowledge and confidence using in-EHR formulary-status messaging.”

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
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Morning Headlines 12/12/17

December 11, 2017 Headlines 1 Comment

Hopkins taps Duke executive to head medical system

Johns Hopkins Health System names Kevin Sowers, current president and CEO of Duke University Hospital, as its next president.

More delays, cost overruns hit Vancouver electronic health project

In Canada, a local paper profiles the Cerner implementation at Vancouver Coastal Health, the Provincial Health Services Authority, and Providence Health Care, which executives say is now $130 million over budget and a year behind schedule.

HHS announces the winners of the HHS Opioid Code-a-Thon

HHS announces winners from its Opioid Code-a-Thon, an innovation challenge that attracted 50 teams comprised of programmers and public health advocates that worked together for 24 hours to create data-driven tools that could be used to combat the epidemic.

OIG Advisory Opinion No. 17-07

HHS OIG approves a pilot program that will allow a pharmaceutical manufacturer to fund and implement integration points between a community hospital and community pharmacists so that pharmacists would gain real-time access to patient discharge information.

Curbside Consult with Dr. Jayne 12/11/17

December 11, 2017 Dr. Jayne 4 Comments

At times, being a consultant feels more like being a therapist than a business person. We see clients at their best and at their worst and try to help them figure out how to replicate the good times and how to avoid repeating the bad times. Some days, I really feel for the vendors trying to work with these clients.

In recent engagements, we seem to be increasingly leaned on to try to mediate between vendors and clients or at least mitigate situations that are starting to turn bad. These situations tend to illustrate a variety of organizational pathologies, whether it’s the client and vendor not being able to work well together or the client (or vendor) having internal dysfunction.

Case in point: one of my clients hired their EHR vendor to build some content for custom clinical workflows in a specialty that the EHR vendor doesn’t support. There were plenty of meetings to define the scope of the project, outline the proposed build, obtain stakeholder signoff, etc. The vendor’s team performed the build and delivered it to the client environment for testing. While the build was occurring, the client re-prioritized its projects and failed to provide any client-side resources to perform user acceptance testing on the delivered work product.

There were a lot of back-and-forth communications that were fairly ineffective and some loud chatter at the client about whether the work was authorized or whether they were going to pay for it. The vendor was at the mercy of the dysfunctional client, with time spent creating templates and the vendor now wondering if they were going to be paid.

I worked with some of the client core team to explain that their counterparts on another team had authorized the build and had generated a work order to the vendor, based on leadership requests to enable documentation tools for that specialty so they could retire their paper charts. The core team members didn’t seem to understand that the initiative was even going on, and once they were pulled in to be a part of it, they took their anger at their peers out on the vendor. It didn’t seem like the different teams at the client site were able to realize that there might be more to the story, and my team had to step in to get them talking.

The ensuing conversations revealed that probably the not all the stakeholders were included in the project and that the templates might not meet the practice’s needs. Word on the street was that there was a good likelihood that the vendor was going to have to go back to square one.

What was really disturbing about this situation was the client’s assertion that it was the vendor’s fault and that the vendor should perform the re-work for free. The vendor’s customization team provided all kinds of documentation, meeting minutes, build specification signoff, etc. that showed client approval of the project as it moved through various process tollgates. But the people signing off weren’t the “right” people and the client failed to see that the problem was its own fault and not the vendor’s mistake.

The vendor tried to meet the client in the middle and offered a 50 percent discount on the services needed to restart the project and ensure the newly-identified “right” resources were involved, as a gesture of their partnership, but the client dug its heels in and refused to participate until the vendor agreed to perform the as-yet-undefined future services for free.

I can’t fault the vendor here. What the client did is tantamount to ordering something at a restaurant, eating the whole thing, and then deciding it wasn’t what you wanted or that it wasn’t any good. Even worse, instead of asking for a different entrée, you ask for the restaurant to agree to give you however many items you might want off the menu to make up for your decision, without boundaries.

From a business perspective, it doesn’t make sense, but the client continued to push it despite the vendor’s willingness to meet them halfway. The client continued to behave badly, trotting out the threat that maybe they should consider a different vendor since their current one didn’t offer the specialty in question. The vendor reacted as expected, explaining that they’ve never claimed to support that particular specialt, and had worked diligently to meet the client’s needs. The client wasn’t having any part of it, though, and continued to assert that everything was the vendor’s fault.

Since my team was hired to implement the new specialty, I had a vested interest in getting the client to get on board with what the vendor had proposed as a remediation strategy. There were several 1:1 conversations with various client leaders and managers to try to get them to understand what had happened to date in a neutral conversation without the finger-pointing and blame-laying that we might see in a group discussion. Then I tried to bring them to the table to discuss it as a team and to figure out how to move forward.

Meanwhile, the implementation timeline continued to slip as did the practice’s confidence in the ability of anyone to get them onto the system with the rest of their colleagues. The group meeting was a lesson in coaching angry people how to have a productive conversation to move an initiative forward, regardless of how they felt about it or whose fault they thought it was. I was having flashbacks to the behavioral therapy components of my residency training. We would agree to baby steps to move the project forward and then someone would say something that inflamed someone on the other side of the table and we would take two giant leaps backwards.

Eventually we agreed to have the physicians in question take a look at the workflows that had been created and identify how far off they were from the mark. Since at least one of the physicians was involved in signing off on the build, I hoped they were at least partially usable. It turned out they just needed a few tweaks and the creation of one additional workflow for a clinical scenario that wasn’t represented in the original set, and due to the small amount of work needed, the vendor offered to do it for free just to get things back on track. Still, it was a tense four weeks as we tried to work this out, and previously decent relationships were damaged without good reason.

As painful as situations like this are, as a consultant, they are our bread and butter, not only because we can help resolve the situation, but because they identify future work that needs to be done. In this case, there clearly needs to be a review of how they want to onboard new specialties and how stakeholders will be identified when custom content is requested. There also needs to be discussion about how these projects will be socialized by the leadership team to the management team and whether certain criteria need to be met for them to move forward.

We’ll see if they want to engage with a formal project in this area, but due to the budget constraints many organizations face, there’s usually not a lot of money for process initiatives because they’re sometimes considered “soft skills.” I guarantee that what they would spend on a small process project would still be less than the cost of the delays, wasted time, and loss of forward momentum exhibited here.

A new fiscal year is coming, so we we’ll see if it makes the budget.

Have any stories about “soft skills” projects your company needs but continues to avoid tackling? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/11/17

December 10, 2017 Headlines No Comments

The White House will convene a meeting on EHR interoperability this Tuesday

Jared Kushner and CMS Administrator Seema Verma will chair a half-day session that addresses interoperability, authentication, and accelerating progress.

Philips expands its Population Health Management business with the acquisition of VitalHealth

The Netherlands-based, 200-employee population health management software vendor was co-founded by Mayo Clinic and Noaber Foundation in 2006.

Hospital Giants in Talks to Merge to Create Nation’s Largest Operator

Ascension and Providence St. Joseph Health are reportedly discussing a merger that would create a 191-hospital system with $45 billion in annual revenue.

Historical Perspective on Health System Modernization Contracts and Update on Efforts to Address Key FITARA-Related Areas

A GAO report finds that the VA spent $1.1 billion on four failed efforts to modernize VistA.

Monday Morning Update 12/11/17

December 10, 2017 News 16 Comments

Top News


The White House’s Office of American Innovation will host a half-day meeting Tuesday on EHR interoperability, led by Jared Kushner and CMS Administrator Seema Verma. Thanks to the reader who forwarded the agenda, which did not include a list of invitees. Working groups will address four topics:

  • How CMS, ONC, and HHS can encourage interoperability and accelerate its timeframe.
  • The methods of authentication that could be used and how can the industry can be aligned to support them.
  • How patients and physicians can be engaged in interoperability and how and any HIPAA issues can be addressed.
  • How can the private sector can become engaged and their participation jump-started by the government’s release of claims or other data.

HIStalk Announcements and Requests


Fairly few male readers are worried that incidents in their past could result in new claims of sexual harassment. HarassedMan was pursued by a male superior and urges employers to provide clear training, policies, and enforcement procedures. HISJunkie wonders whatever happened to innocent until proven guilty and also suggests that a man who is terminating a female employee for cause think carefully about the situation.

New poll to your right or here, continuing last week’s poll: women, what kind of sexual harassment have you experienced? I found my inquiry limited by the format of a poll, so perhaps I’ll follow up with a survey to answer questions such as:

  • Did you rebuff the advances, and if so, did it hurt your career?
  • Did you report it to HR, and if so, was the issue resolved to your satisfaction?
  • If you didn’t rebuff or report, why not?
  • Have you ever provided sexual favors or accepted sexual situations — or worked with someone who did — to get hired or to improve job prospects? This is hard to ask, but it happens and encourages bad situations for others. I feel sorry for a man or woman who successfully stops an uncomfortable situation but sees their job suffer because co-workers accept it as quid pro quo.
  • Are you considering taking any legal action or going public with incidents from your past?


Three dozen clinician respondents are mixed on whether hospital VIP patients have better clinical outcomes. Nearly half say yes, while around one-fourth each say the outcomes are the same or worse as in the cheap seats. I was appalled at my first hospital job in learning that my for-profit employer – whose outcomes were universally terrible, as you would expect when bean counters oversee all the clinical decisions of a badly educated medical staff recruited for obedience and volume rather than quality –cleared an entire hallway to house the hypochondriac mother of our very profitable eye surgeon. Our profit-obsessed executives convened emergency department head meetings to make sure everybody figuratively genuflected to meet her every need (I got stuck running out to get the kind of wine she preferred since our nutritional services people could barely open cans and heat up food service frozen entrees) and made rare appearances in patient care areas only because she was propped up back there like a queen. At least working for a for-profit hospital shortened the path to my disillusionment with hospitals and maybe humanity in general.

Listening: new from Bully, Nashville-based grunge rockers who sound like Hole mixed with the Breeders. The tiny female singer, who has a rather chirpy conversational voice but can really belt it out cathartically when singing, looks quite a bit like Lucy in the original “Twin Peaks.” 


Friend at Impact generously donated $1,000 to my DonorsChoose project, asking that I focus on elementary school STEM materials (which I’m quite happy to do since I usually seek those out). I applied a dollar-for-dollar match from my anonymous vendor executive plus other matching (the $1,000 donation ended up fully funding a stunning $8,200 worth of grants) for these projects in schools whose students are almost all from low-income households:

  • Lab coats, goggles, science journals, and activity kits for Ms. G’s fourth-grade class in Los Angeles, CA.
  • An IPad for running programmable robot kits for Ms. S’s elementary school technology club in Los Angeles, CA.
  • Three video cameras for home science experiments for Mrs. S’s third-grade class in Philadelphia, PA.
  • STEAM activity kits for the after-school elementary school program of Mrs. M in Springdale, AR.
  • Math activity kits and games for Mrs. H’s elementary school class for the deaf and blind in Mobile, AL.
  • Programmable robots for Mrs. W’s elementary school class in Cartersville, GA.
  • Programmable robots for Mrs. O’s elementary school class in Garland, TX.
  • STEM kits and experiment books for Mrs. A’s elementary school class in Detroit, MI.
  • Six electronic note pads for Mrs. N’s elementary school class in Farmville, MI.
  • Take-home math and STEM games for Mrs. F’s elementary school class in Mescalero, NM.
  • A STEM bundle for Mrs. T’s kindergarten class in Dallas, TX.
  • Take-home math game bags for Ms. M’s elementary school class in Bronx, NY.
  • STEM games for Mr. M’s elementary school class in Milwaukee, WI.
  • Weekly take-home science projects for Ms. I’s elementary school class in Oxnard, CA.

This Week in Health IT History

One year ago:

  • President Obama signs the 21st Century Cures Act into law.
  • The Wireless-Life Sciences Alliance trade group and the HIMSS-owned Personal Connected Health Alliance merge.
  • CommonWell Health Alliance and Sequoia Project’s Carequality announce plans to connect their respective systems.
  • The American Heart Association, AMA, DHX Group, and HIMSS launch the non-profit Xcertia to establish best practices for mobile health apps.
  • SocialWellth brings back the Happtique app certification program.
  • MD Anderson considers layoffs and research cutbacks after losing $102 million in the first two months of its fiscal year, with the cost of its Epic implementation being one of four factors hurting its bottom line.

Five years ago:

  • Mediware acquires inpatient rehabilitation and respiratory services documentation systems vendor MediServe.
  • Allscripts sues NYC Health + Hospitals for choosing Epic at what the company says is a $535 million premium to its own bid, to which the health system responds that Allscripts lacks an integrated EHR and that the company is suing to try to prop up its sagging share price.
  • McKesson Paragon beats out Cerner as the #2 product suite behind Epic in Best in KLAS, while Agfa, McKesson, and Allscripts were ranked as the worst vendors overall.

Ten years ago:

  • MedAssets conducts its IPO.
  • Dairyland Healthcare brings in a new executive team following its acquisition by Francisco Partners.
  • NextGen creates a revenue cycle management division for physician practices.
  • Philips acquires ICU monitoring technology vendor Visicu for $430 million, paying 12 times Visicu’s annual revenue.

Last Week’s Most Interesting News

  • FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).
  • Dignity Health and Catholic Health Initiatives announce plans to merge in creating the country’s largest health system in terms of revenue.
  • Advocate Health Care announces plans to merge with Aurora Health Care.
  • The Sequoia Project announces that its Carequality initiative connects more than half of all US healthcare providers, with 1,000 hospitals, 25,000 clinics, and 580,000 providers exchanging 1.7 million clinical documents monthly.
  • CVS announces an agreement to buy Aetna for $69 billion.
  • Former GE CEO Jeff Immelt says the company tried to buy Epic but was immediately rebuffed and also considered acquiring Cerner but thought the $2 billion price was too high.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock


Philips acquires Netherlands-based, 200-employee population health management software vendor VitalHealth Software, co-founded by Mayo Clinic and Noaber Foundation in 2006. The company expands the informatics work Philips started with its acquisition of Wellcentive in 2016. Philips acquired Netherlands-based interoperability software vendor Forcare last week.


Patient payments technology vendor Cedar raises $13 million in a Series A funding round. Co-founder Florian Otto, DDS, MD, PhD was sales VP for ZocDoc before starting Cedar in April 2016.

image SNAGHTML8472988f

The urge to merge reaches manic levels as Ascension and Providence St. Joseph Health are reportedly talking about combining to create a 191-hospital system with $45 billion in annual revenue, eclipsing last week’s signed agreement between Dignity Health and Catholic Health Initiatives that set the short-lived annual revenue record of $28 billion. Ascension is a Cerner shop, while Providence St. Joseph Health – formed in a July 2016 merger — uses Epic, Meditech, and Allscripts.


  • Albion Family Practice (PA) will switch from Allscripts to Epic ambulatory EHR in 2018.
  • Saratoga Hospital Medical Group (NY) went live with Athenahealth ambulatory EHR in Q4 of 2017.
  • Munroe Regional Medical Center (FL) switched from Medhost to Cerner in 2017.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.



Atlantic Health System promotes Ben Bordonaro to chief administrative information officer.

Government and Politics


A GAO report finds that the VA spent $1.1 billion on four failed efforts to modernize VistA – HealtheVet, iEHR, VistA Evolution, and EHRM. GAO also notes that the VA has requested $4.1 billion for IT in 2018. Among the 15 key VA contractors on the failed projects was Cerner, who will sell the VA its VistA replacement system. An interesting tidbit from the report is that two of the VA’s systems are over 50 years old, both of them COBOL-based mainframe systems.

Privacy and Security


UNC Health Care (NC) notifies 24,000 patients that their PHI was contained on an unencrypted laptop stolen from a dermatology practice it had acquired in 2015. The health system pledges in the announcement to do a better job of reviewing the security of practices it acquires.



In England, Royal Surrey County Hospital goes back to paper scheduling after an upgrade to its Allscripts system fails. I think they are using the Oasis Medical Solutions PAS, acquired by Allscripts in mid-2014.


I ran across Medsender, a company I hadn’t heard of that promises to end 100 percent of medical record faxing or else there’s no cost to the customer. The company claims the product can be installed in 60 seconds and works with any EHR. Founder/CEO Zain Qayyum developed the product in 2014 while attending Marist College full time. 


The operating income of UMass Memorial Health Care (MA) declined 74 percent in the fiscal year that ended September 30, with executives noting a modest increase in insurer payments, its $200 million in capital projects, and a $700 million Epic implementation that has taken doctors away from their revenue-generating clinic work as they build the system.

Sponsor Updates

  • Sunquest Information Systems hosts its 19th annual holiday toy drive for Aviva Children’s Services.
  • Surescripts will exhibit at the Health Care Law Institute 2017 December 14 in New York City.
  • A national IDN upgrades to ZeOmega’s Jiva 6.1 population health management platform.
  • LogicStream Health will exhibit at the IHI National Forum December 10-13 in Orlando, and will host a poolside party December 11 from 6:30-8:30pm ET.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.


Morning Headlines 12/8/17

December 7, 2017 Headlines No Comments

Statement from FDA Commissioner Scott Gottlieb, MD on advancing new digital health policies to encourage innovation, bring efficiency and modernization to regulation

FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).

Dignity and CHI sign definitive agreement to merge

Dignity Health and Catholic Health Initiatives will merge to create the country’s largest health system as measured by operating revenue.

Apple health exec Anil Sethi leaves to form new healthcare records startup

Apple’s health director Anil Sethi leaves to focus on his medical information sharing startup Ciitizen.

Using Electronic Health Data for Community Health

A report from public health grant-making organization De Beaumont Foundation and Johns Hopkins University presents use cases describing how public health agencies could use provider EHR data without running afoul of HIPAA.

News 12/8/17

December 7, 2017 News No Comments

Top News


FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).

FDA will focus its attention and medical device status on software that analyzes medical images, physiological monitoring data, sound waves, sleep apnea monitor data, spectroscopy data, and slide pathology, as well as software that uses undisclosed algorithms.


FDA says software isn’t a medical device just because it:

  • Uses patient information to present treatment guidelines and drug interaction / allergy alerts.
  • Offers prioritized alternatives to orders and drugs using generally accepted practices.
  • Suggests an intervention or a test consistent with clinical guidelines or drug labeling.
  • Makes suggestions for chemotherapy.
  • Uses rule-based tools to compare patient data to practice guidelines.
  • Provides tools, calculators, or protocols for TPN or enteral nutrition. 
  • Provides patients with prescription reminders and instructions that are consistent with FDA labeling.
  • Helps patients choose a non-prescription drug based on their symptoms.
  • Is intended only for healthcare facility use.
  • Allows patients to document or illustrate their conditions with their providers.

FDA also says it will not enforce its own requirement that electronic patient software be classified as a medical device if it isn’t certified by ONC.

Software that stores, converts, or displays medical images will also be moved to non-device status, but software that analyzes the images will be treated as a medical device.

Software that flags patient results based on specific parameters (such as out-of-range results or opportunities for complementary tests) will not be regulated as a medical device as long as it only performs the same interpretation that the practitioner could do themselves.

HIStalk Announcements and Requests


CompuGroup Medical and its US CEO Benedikt Brueckle donated $500 to my DonorsChoose project, which when matched with funds from my anonymous vendor executive and other sources (I found some GREAT matching, as you’ll see, $5 for each $1 in some cases) fully paid for these classroom projects:

  • STEM games for Mrs. S’s fourth-grade class in Columbus, OH.
  • A mobile science lab for Mrs. N’s middle school class in Bay Shore, NY.
  • Ten sets of headphones for Ms. M’s elementary school class in Philadelphia, PA.
  • A library of 30 fiction and non-fiction books for Ms. E’s elementary school class in Bronx, NY.
  • A carbon dioxide meter and air quality mapping supplies for Mrs. E’s elementary school class in Detroit, MI.
  • A STEM activity table for Mrs. S’s elementary school class in Malden, MA.
  • STEM activity centers for Ms. Z’s pre-kindergarten class in Fort Worth, TX.
  • Air quality meters for Mrs. A’s fifth-grade class in Greenville, PA.
  • A three-day environmental science mountain camping trip for Mrs. V’s fifth-grade class in Los Angeles, CA.

Several teachers, including Ms. E, responded almost immediately: “We want to thank you for your warm heart and generosity. I can’t begin to tell you what it means to these kids to have information at their fingertips! They are kind-hearted, sweet, intelligent kids who sometimes just need a little boost and you are a part of them. Again, thank you, and we will send pictures after we get the books. Our classroom is a better place because of your awesome contribution.”

This week on HIStalk Practice: Burke Pediatrics (VA) partners with Food for Others as part of a new food prescription program aimed at ensuring patients can put healthy food on their tables. The Y builds out health IT infrastructure with HIPAA compliance, cybersecurity services. Teladoc drops lawsuit against Texas Medical Board. AJC investigation highlights physician contributions to opioid epidemic. CyberKnife Center of Miami selects Identillect. Aprima integrates DocBuddy voice recognition. HealthiPass raises $7.2 million. UnitedHealth buys DaVita Medical Group in multi-billion dollar deal.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock


Dignity Health and Catholic Health Initiatives sign a merger agreement that will create the country’s largest health system as measured by operating revenue. The new Catholic health system will have $28 billion in revenue, 139 hospitals, and 159,000 employees, operating in 28 states. The CEOs of each organization will become co-CEOs of the new system. Dignity uses Cerner, while I believe CHI runs a mix of Meditech, Allscripts, Cerner, and Epic.


I’m interested that the asset management company co-owned by Nobel-winning economist Richard Thaler – which focuses on shares that are mispriced due to irrational investor psychology – holds 2.8 percent of the outstanding shares of Allscripts, worth around $72 million. MDRX shares are up around 12 percent over the past 12 months (vs. the Nasdaq’s 48 percent) and 30 percent over the past five years (vs. the Nasdaq’s 129 percent). It’s Thaler’s theories rather than his investing acumen that earned him a Nobel — the Fuller & Thaler Behavioral Small-Cap Equity fund has performed consistently worse over several years than the Dow, Nasdaq, and S&P 500.


A Huffington Post article profiles ReHAP, an algorithm-driven system for hospitals to help hospital rehab therapists identify and prioritize patients who need their services. The co-founder is Krishnaj Gourab, MBBS, who is chair and medical director of rehab informatics and analytics at Johns Hopkins Bayview Medical Center (MD).


An Axios financial analysis of 84 large health systems finds that while their patient care margins are slim, they’re making a fortune with their Wall Street investments and M&A activity in raising their overall average profit margin to 6.7 percent on their huge revenue volumes, with the article concluding, “Large not-for-profit hospital systems now resemble and act like Fortune 500 companies instead of the charities they were often built as. They consequently hold immense financial and political power.” The analysis unfortunately and rather obviously mixes up “millions” with “billions” in the pop-up graph legends, but commendably provides the raw data as Google Docs spreadsheet. The most profitable health system is Kaiser Permanente at $3.1 billion in FY2016-27 profit, of which 38 percent was generated by its investments. To take the counterpoint, one contributing factor in the success of any charity is to accumulate enough assets to iron out the operational cash flow challenges, although people often get suspicious when those war chests swell and executives take home multi-million dollar salaries. Not to mention that the stock market won’t always perform as well as it has lately.


Anil Sethi, MS – who became director of Apple Health in 2016 after the company acquired his personal health record company Gliimpse — will leave Apple to focus on his new startup Ciitizen. Former ONC Chief Privacy Officer Deven McGraw, JD, MPH also works for Ciitizen, which helps people obtain and share information and health-related legal documents.  


Medical Society of Delaware chooses HealthEC’s population health management system and services for its 900-doctor clinically integrated network.

Announcements and Implementations


Solutionreach announces SR Schedule, which allows physician practices to offer the patients easy self-scheduling. 


Aprima integrates its EHR with DocBuddy voice-powered physician workflow for mobile devices. A hand surgeon early adopter says it saves him 45 minutes per day.


EBroselow will integrate ASHP’s AHFS DI Essentials database into its SafeDose bedside dosing application.

Government and Politics

The rate of growth of US healthcare spending slowed in 2016, but still increased by $354 per capita to $10,348 in consuming 17.9 percent of the gross domestic product.



A report from public health grant-making organization De Beaumont Foundation and Johns Hopkins University presents use cases describing how public health agencies could use provider EHR data without running afoul of HIPAA.


A TransUnion report on Millennials finds that 60 percent don’t understand their health insurance benefits. They also also pay their medical bills more slowly than other generations, mostly because they entered the workforce as lower-income employees just as employers shifted more healthcare payments onto consumers and thus they don’t have the money. The report suggests that providers educate Millennial patients at the point of service, give them an upfront cost estimate when possible, and encourage them to pay at the time of service.


The Indianapolis paper profiles Chuck Dietzen, MD, medical director for pediatric rehabilitation at Riley Children’s Health (IN); founder of the non-profit Timmy Global Health; and co-founder and chief medical officer of EHR/PM vendor ISalus Healthcare.


St. Joseph Healthcare (ME) will eliminate 24 jobs as parent organization Covenant Health centralizes billing after completing its Cerner implementation.


Fun from The Onion.

Sponsor Updates

  • LogicStream Health launches clinical process modules for sepsis, CAUTI, and VTE.
  • Nordic releases a new podcast, “Consolidating your EHR after a merger or acquisition.”

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.


EPtalk by Dr. Jayne 12/7/17

December 7, 2017 Dr. Jayne 2 Comments


A new survey from the University of Utah looks at how different healthcare stakeholders define value by querying physicians, employers, and patients. Working with Leavitt Partners, they’ve assessed how those groups view quality, cost, and service. I’m not surprised by the findings that nearly 90 percent of physicians equate quality and value, since we’ve had the importance of quality metrics drummed into us for years.

The survey found that employers focus more on cost and patients are most often looking at whether out-of-pocket costs are affordable. That’s not to say that physicians don’t consider cost – it found that more than 75 percent of us consider cost when they make treatment decisions. Unfortunately, we don’t always have an idea of what some of the procedures or medications we recommend might be billed at, let alone how 20 or 30 different payers are going to handle them and where a given patient is on his or her out-of-pocket or deductible limit.

I ran into this recently when trying to have new orthotics made. I know my insurance doesn’t cover them, so wanted to wait until January to order them when I have cash in my flexible spending account again. The physician swore my payer had changed its plan, not realizing that even though I have Big Payer’s name on my card, that I’m part of a self-insured group that uses the network but has a number of carve-outs. Needless to say, they now have my measurements on file, but I’ll be calling back in January to put the order through. They also insisted on charging me a co-pay even though I had documentation that I had met my out-of-pocket maximum this year and no longer needed to pay it, but that’s another story.


Road warriors beware: the New York Times ran a piece last week looking at the health problems of frequent travelers. It’s not just colds and jet lag any more, but obesity, high blood pressure, and more that we have to worry about. The article mentions a 2015 Harvard Business Review article that looked at frequent business travel as a cause of early aging and increased risk for cardiovascular events with more than 70 percent of business travelers reporting unhealthy lifestyle symptoms such as stress, mood issues, digestive problems, lack of exercise, and excess drinking. I’ve seen plenty of the latter in other business travelers, including a consultant who no longer does work for me due to his submission of a lunch receipt that contained four martinis while he was on site with a client.


One of the benefits of working for yourself is making your own schedule. Of course, that schedule is largely driven by the needs of my clients. I’m generally able to accommodate them, but this year I made the tail end of November and all of December a “no fly zone” in an attempt to stay home for longer than two weeks in a row. I’ve been successful, but the consulting karma has caught up with me as I’ve been inundated by clients expecting me to pull a rabbit out of the hat at the end of the year. Usually these requests are around things such as HIPAA Security Risk Assessments, when organizations realize that either they didn’t know they had to do one, they knew they had to do one but just didn’t, or the person who normally does it has left the practice. I subcontract with two vendors who are willing to handle these folks well into the eleventh hour, so I can’t complain.

This year’s end-of-year rush brought me a couple of twists. The first was a client who has decided they need to stand up a Health Information Exchange “or something like it” by the end of the year to comply with the requirements of a grant that they’ve already spent on other things. Of course, they want this done cheaply and quickly, but don’t have any resources to do it and aren’t familiar with their vendor’s current solution offerings. We spent several hours on the phone discussing the options, including secure messaging, which would be slam dunk given their vendor’s built-in workflows. They came back with the traditional excuse that their practice is so different from anyone else’s that they couldn’t possibly make that happen with the prescribed workflow. We discussed other solutions that would cost much more money and be more risky from a timeline perspective, and in the end, they couldn’t make a decision because one of the key stakeholders is out of the office for the next week. But when he comes back, they want to start immediately even though no one has his proxy or signatory authority for a contract.

The second twist was a potential client who hadn’t looked at their quality metric tracking reports for several months following the departure of a key employee. They didn’t fully understand what her role and responsibilities were, and everyone assumed that someone else was picking up the reporting. Now that they’re in the bottom part of the year, they have run the reports and the performance of several physicians is well below the benchmark. The practice determined that several workflows were in error and were shopping around to see if someone would help them modify the database to “correct” the erroneous workflows. I feel their pain, but I’m not one to putter around in someone’s database, especially where an attestation is on the line, so I took a pass.

The next twist was a rescue mission for a new client who recently upgraded their EHR. Despite warnings to the contrary, they elected to retire 100 percent of their custom workflows in favor of out-of-the-box functionality. They failed to perform any kind of user acceptance testing and didn’t require the providers to attend training, so when Monday morning arrived, it was a total calamity. They were initially looking for someone who would revert their database to pre-upgrade shape, but since they had three days of partial patient documentation in the system, that was a no-go.

I martialed some consultants and a couple of trainers to join me in an after-hours training marathon, where we tried to get the providers up to speed before Thursday hit. I’ll be in command center mode all day Thursday and Friday, so wish me luck. The staffers I brought in are delighted to have the extra hours and bonus pay in the weeks before Christmas, but I’m exhausted, and if I have to listen to one more physician complain that they hate the upgrade but they didn’t go to training, I’ll scream. On the bright side, they had already committed to some extensive governance and change leadership work starting after the first of the year, so I know I’ll have a receptive audience if they’re still standing after this week.

Seeing any end of the year madness at your workplace? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/7/17

December 6, 2017 Headlines No Comments

National Health Expenditure Report Shows We Have Not Solved the Cost Problem

The latest update on health spending from CMS shows that spending grew 4.3 percent in 2016 to $3.3 trillion, representing 17.9 percent of the GDP.

Framework for Improving Critical Infrastructure Cybersecurity

NIST publishes a draft update of its Cybersecurity Framework.

Henry Ford Health data breach affecting 18K patients

Henry Ford Health System notifies 18,470 patients that someone gained unauthorized access to the email credentials to employees that would have allowed them to access patient information, including “name, date of birth, medical record number, provider’s name, date of service, department’s name, location, medical condition, and health insurer,” but not social security number or credit card information.

House lawmakers: VA Choice reform bill can wait until 2018

VA committee Chair Phil Roe (R-TN) says that the Veterans Choice program is no longer in danger of running out of funds and can wait until early 2018 before new funding legislation is needed.

CIO Unplugged 12/6/17

December 6, 2017 Ed Marx 2 Comments

The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.

New Math

All of us serving in IT are being asked to do more with less. Given the emergence of digital tools and connectivity, there is no reason to expect less. Tools and processes are critical if we hope to enable health and wellness transformation, but leadership trumps all. When I study major blockers in my own experience, it comes down to leadership. Leaders who continue to use old formulas are what I call old math. We need new math. 

New Math

We must become selfless leaders. A selfless leader is a humble servant who puts the organizations and other individuals before themselves. They eat last. They sleep last. They give away their best. They open doors. They sacrifice. They lead by example.


Above is a picture of the then-CEOs of Texas Health Resources and University of North Texas Health Sciences cleaning human waste in the Tanzanian medical clinic we co-founded in 2011. He who wants to be first among us needs to take the last place. 

Right for the Organization

We are all proud of our domains and departments. We all love to show off our results. Super! You should be proud. But do not let pride harden your heart and cause you to stumble to the point you forget it’s about the organization’s mission and vision and not your trophy case.

Always keep the organization’s best interest first. The rest will follow. I learned over the years that the more control I give up, the more influence I gain. I once gave up my CMIO, CNIO, and BI and the IT influence did not suffer, but was multiplied many-fold. The organization prospered. It is backwards math, but it is what I refer to as new math.

Right for the Person

Sometimes we can hold on so tightly to our own people that we squeeze life from them. Let them go. If they want to stay, they will, but let them choose. We are doing our people a disservice when we don’t let them reach their full potential. Often, it drives them to leave the organization.

Instead, let’s give them room to grow with us. Nothing better to see one of your own grow and surpass you. That is a compliment. I can point to several people who served with me that are way better. Many went on to surpass me. I love it!

When someone makes a hero out of one of my peers or team, I am not threatened. I got over that long ago. Let them shine. Help them shine. Let them move on and flourish. Give away your best. The less we hold on, the less we stress. The more we give away, the more we receive.

Every time I have given away my best, someone else comes along, and we hit a new level. Another head-scratching new math principle.

Replicate Yourself

You are a gifted leader only when you replicate yourself. As good as you are, you are only one person. You are limited to one. One is too small a number.

When you replicate yourself, you open the gift of multiplicity. It is what we called in the Army a force multiplier. Instead of one of you, there are now two, and you accomplish 4x. Yep, more funky new math.

Some people like to brag about the greatness of their leadership, but the first thing I ask about is the pipeline. Yep, the pipeline of fresh talent that then infuses the company and the industry and the world. How many CIOs have you helped build?

A great test is voluntary followership. If you go to another company, how many people follow you? How many people pack their bags and follow you? Or are you one of those leaders who attend every meeting of your subordinate leaders? Are you afraid to let your directors or manager lead without you there? Tough questions, but we have to be real. How is your new math?

Protect One Another

Would you sacrifice for one another? I had to ask myself that many times as a combat-trained medic and combat engineer officer. Thankfully, I never faced battle, but I prepared as if I was getting called to the front lines. We soldiers asked ourselves all the time if we could trust our foxhole buddies. Would they jump on that grenade? Would they take a bullet from your flank?

When in public, we must be unified. We can and should respectfully fight behind the scenes to challenge one another before finalizing decisions and closing ranks. My expectation is that publicly we are one and fight for one another. If someone is bullied, you stand up. If someone is struggling, you walk beside them and carry them if needed. If someone is lost, you help them with directions. If someone is new, you introduce them and never leave them.

You give up your seat at the table. Secure leaders go out of their way to give up their seat. The more you serve and protect and seek the best in another before yourself, the brighter you shine. New math. You have to love it.   


I have great hope that those of us who are privileged to lead will become selfless. That we might tell a colleague, “Please take Mary. She is the best leader I have and she will make that new area rock.” Or, “I love my ABC division to death and it represents my heart and soul, but I can see how infusing pieces and parts into other areas is the very best outcome.” Or, “I love leading this division, but use me as change in your pocket because I’m willing to lead any area you ask.”

Imagine if we had 10 gifted leaders, all concentrated in one area. How does that benefit our patients? Alternatively, what if we took those 10 gifted leaders and strategically placed them throughout the organization? We could change the world. New math.


None of us are perfect. I am likely the most imperfect and average leader there is. But I embrace change and strive to put others before myself. I see many of my gaps and get help. I am unafraid to ask for help. I am unafraid to say I don’t have any idea.

When is the last time you proactively sought training or reached out to a coach or formal mentor? Self-reflect. Assess your gaps, Make a plan. Fill the gap. Wash feet. Repeat. Constantly. New math.


Ed encourages your interaction by clicking the comments link below. He can be followed on LinkedIn, Facebook, and Twitter.

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